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Hospitalization for the Initiation of Ketogenic Diet (CPB 0226, reviewed 2026-04-23)
Effective date
Not stated in the notice
Identified
Aug 18, 2026
Summary
Aetna considers hospitalization for initiation of a ketogenic diet medically necessary for intractable seizures, including Doose syndrome and Lennox-Gastaut syndrome, when all listed selection criteria are met, and for persons with glucose transporter protein type 1 deficiency or pyruvate dehydrogenase complex deficiency. Aetna considers hospitalization for initiation of a ketogenic diet of unproven value for all other indications, including adult super-refractory status epilepticus, Alzheimer's disease, autism spectrum disorder, cancer, migraine prevention, multiple sclerosis, Parkinson's disease, schizophrenia and type 2 diabetes. Hospitalization for initiation of the Atkins diet for intractable seizures, mitochondrial diseases, or other indications is considered experimental, investigational, or unproven.
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What to do
Action · 10 steps
01Hospitalization for initiation of a ketogenic diet is medically necessary for intractable seizures when all selection criteria are met.
02The member must have failed to respond to or be intolerant of anticonvulsant medications (monotherapy and polytherapy), after an adequate trial of drug therapy with the correct medications at the correct dosage, careful monitoring, and compliance for at least 1 year.
03The member must be younger than 18.
04Parents or family members must be willing and dedicated to support compliance.
05There must be reason to believe the outpatient setting will not be safe or effective because of a member-specific underlying health condition.
06The hospital stay depends on the proposed initial starvation period and generally should not exceed 3 days.
07Most Aetna plans exclude coverage of dietary supplements, so check benefit plan descriptions for details.
08Those plans do not cover any food supplements for the ketogenic diet.
09Determination of variants in BAD, KCNJ11, and SLC2A1 to predict response to ketogenic dietary therapies for epilepsy is considered experimental, investigational, or unproven.
10There is no specific code for hospitalization for initiation of a ketogenic diet.
Codes mentioned
81000810039780297804A4250A9152A9153S9470E74.4E88.09G40.009G40.019G40.109G40.119G40.209G40.219G40.309G40.319G40.A09G40.A19G40.B09G40.B19G40.409G40.419G40.509G40.802G40.804G40.822G40.824G40.909G40.919G40.811G40.814C00.0C96.9E11.00E11.9E72.04E88.40E88.49F20.0F20.9F31.0F31.9F32.0F39F84.0F84.9G20.A1G20.CG21.0G21.9G30.0G30.9G35.AG35.DG40.001G40.011G40.101G40.111G40.201G40.211G40.301G40.311G40.A01G40.A11G40.B01G40.B11G40.401G40.411G40.501G40.801G40.803G40.813G40.821G40.823G40.901G40.911G43.001G43.919G43.B0G43.B1G43.D0G43.D1P91.811P91.819Q61.11Q61.19Q61.2Q61.3Q87.11S12.000AS12.691SS13.0XXAS13.9XXSS14.0XXAS14.0XXSS14.101AS14.9XXSS22.000AS23.9XXSS24.0XXAS24.159SS32.000AS32.2XXSS33.0XXAS34.9XXS
Original notice
Hospitalization for the Initiation of Ketogenic Diet (CPB 0226, reviewed 2026-04-23)
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